| NPI | 1457076127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171WH0202X Contractor, Home Modifications | |
| 252Y00000X Early Intervention Provider Agency | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-05 |